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Course: Maternity Nursing

Topic: Fetal Development and Circulation Part 2

The Nurses International Community

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Module Goals

The learner will be able to:

Describe the function of amniotic fluid
Identify the structure and function of the placenta
Describe fetal circulation

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Amniotic Fluid and Amniotic Sac

Amniotic Sac: Transparent thin double membrane that holds amniotic fluid during the entire gestation

The membrane that covers the fetal side of the placenta (amnion) is filled with liquid amniotic fluid.

Amniotic Fluid: A clear yellowish liquid that surrounds the fetus during pregnancy

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Role of Amniotic Fluid

Provides a cushion for the fetus and prevents external injury
Helps to regulate the temperature of the fetus
Aids in movement of the fetus
Prevents pressure on umbilical cord
Helps lungs to develop properly
Normal volume ranges from 500-1500 at term

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What Would the Nurse Do?

A mother-in-law of a pregnant mother says that if a pregnant woman wears anything around the neck or waist (ornaments, scarfs, belts) it will cause the cord of the baby to be long and wrap around the baby’s neck.

How should the nurse respond?

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Placenta

A flat cake-like organ that grows at the wall of the uterus during pregnancy (Johns Hopkins, 2020)
Provides nutrition and oxygen to the fetus
Eliminates carbon dioxide and other waste products of the infant
Performs endocrine, pulmonary,renal and gastrointestinal functions of the fetus

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Placental Attachment

Placenta is attached on two surfaces:

Maternal Surface

Red, rough surface
Flesh-like
Part of the basal decidua will have been separated with maternal surface
Maternal surface has 20 lobes

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Placental Attachment

Fetal Surface

Shiny, gray appearance (covered by amnion)
Umbilical cord attachment
Branches of the umbilical veins and arteries are visible

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What Would the Nurse Do?

During a teaching session for training of traditional birth attendants one of the attendants said that they have been using chicken droppings mixed with cooking oil to apply at the root of the cord (with the help of a chicken feather) and it helps the cord to dry off quickly.

How should the nurse respond?

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Amnion

Umbilical Cord

Chorion

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Placental Fetal Circulation:

Placenta

Exchange of Oxygen in Uterine wall

Oxygenated Blood returns to fetus

Deoxygenated blood

Umbilical Artery

Umbilical Vein

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Fetal Circulation:

Structures:

The umbilical vein
The ductus venosus
The foramen ovale
The ductus arteriosus
The hypogastric arteries

Ductus arteriosus

Left lung

Ductus venosus

Inferior vena cava

Renal vein

and artery

Aorta

Hypogastric arteries

Superior vena cava

Pulmonary artery

Pulmonary veins

Foramen ovale

Right lung

Liver

Portal vein

Umbilicus

Umbilical vein

Umbilical arteries

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Fetal Circulation (Continued...)

The umbilical vein: Leads from umbilical cord to liver, supplies blood & nutrients to the liver
The ductus venosus: Connects umbilical vein to inferior vena cava- partially oxygenated blood
The foramen ovale: Temporary opening between atria- fully oxygenated blood
The ductus arteriosus: Carries the oxygen-poor blood back to the lower organs
The hypogastric arteries: Umbilical arteries, returns blood to the placenta, carries unmixed blood

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The umbilical vein:

Placenta accepts the deoxygenated blood from the fetus via umbilical arteries and after the blood mixes with oxygen, the umbilical vein carries the oxygenated blood and essential nutrients to the underside of the liver. It is then branches to join the portal vein to supply blood to the liver of the fetus itself. This oxygenated blood passes through the liver and enters the right atrium.

The Ductus Venosus:

Connection from a vein to vein. It connects the umbilical vein to the inferior vena cava. At this point, the blood mixes with deoxygenated blood returning from the lower parts of the body via inferior vena cava. Thus the blood throughout the body is at best partially oxygenated.

The Foramen Ovale:

Oval-shaped temporary opening between the left and right atrium. It allows the maximum blood from the inferior vena cava to pass across into the left atrium so that oxygen gets to the brain of the fetus. The reason for the diversion is that the blood here does not need to pass through the lungs to become oxygenated (it is oxygenated upon mixing with the blood from the umbilical vein).

The ductus arteriosus:

A connection between an artery to another artery. It leads from the bifurcation of the pulmonary artery to the descending aorta, entering it just beyond the point where the subclavian and carotid arteries leave. It sends oxygen-poor blood to the lower half of the fetus which it allows the oxygen-poor blood to leave the fetus and return back to the placenta via umbilical arteries to pick up oxygen.

The hypogastric arteries:

These arteries branch off from the internal iliac arteries and become umbilical arteries (after they enter the umbilical cord). They return blood to the placenta. This is the only vessel in the fetus carrying unmixed blood.

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What Would the Nurse Do?

You are a shift nurse in the labour room looking after a mother who is in labor. After a delivery of twins, the family of the client asks why one baby is larger while other is smaller? What would be your best response?

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Red Flags

A 34-week-pregnant woman experiences less fetal movement
Bleeding and severe lower abdominal pain during gestation
Vaginal bleeding during 2nd and 3rd trimesters can indicate placenta previa or abruption
Uterus measures smaller than expected for the gestational age
Uterus measures larger than the gestational age

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Cultural Considerations- beliefs and practices

In many cultures the placenta is considered the child’s guardian angel
In some cultures, the placenta must be buried with certain rituals otherwise it is believed to causes a negative health impact on the mother and the child
In some cultures, if the baby is male, the family believes that the cord of the baby should be cut long in order for the baby to have a long penis

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Glossary

Decidua: Endometrium during pregnancy.
Basal Decidua: The basal layer lies immediately above the myometrium

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References:

Assegid. M. Obstetric and Gynecological Nursing. Ethiopia. Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. 2003.

John Hopkins Medicine (2020). Anatomy: Fetus in Utero. Retrieved on 9^th of September 2020 from https://www.hopkinsmedicine.org/health/wellness-and-prevention/anatomy-fetus-in-utero

Medilineplus (n.d). Medical Encyclopedia: Amniotic Fluid. Retrieved on 9^th of September 2020 from https://medlineplus.gov/ency/article/002220.htm

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